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Gender Healthcare Policy Map

FAIR’s Gender Healthcare Policy Map is a resource of aggregated information affecting gender modification interventions for minors in the United States.

FAIR aims to update this resource in a timely manner. If you have additional information or comments, please contact us at [email protected].

As of February 2024, twenty-three states have passed laws or regulations that raise the age to 18 for gender modification interventions (hormones and/or surgeries), strictly regulate the practice, or defining it as child abuse:

Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Nebraska, Mississippi, Missouri, Montana, North Carolina, North Dakota, Ohio, Oklahoma, South Dakota, Tennessee, Texas, Utah, and West Virginia.

Legal challenges have been launched against several states who passed laws. Arkansas' SAFE Act passed in 2021 was ruled unconstitutional on June 20, 2023. The 11th Circuit Court of Appeals, on Aug. 21, 2023, overturned Alabama's lower court partial injunction on the law to ban hormonal interventions for minors, allowing the complete ban to go into effect. In September 2023, the 6th Circuit Court of Appeals ruled that KY SB150 and TN SB 1 bans are constitutional and may take effect.

Other states have passed laws to create “sanctuaries” to shield against outside laws, or passed state level civil rights laws defining gender as a protected class for anti-discrimination laws. Several cities, including New York City and Kansas City, have declared themselves a “sanctuary city”.

Many of these “sanctuary states” have passed bans on psychotherapy for minors with gender identity disorder by state licensed mental health professionals. The bans are given the misnomer “conversion therapy” because the legislation joins gender identity disorder with sexual orientation. Historically, psychotherapy to change one’s sexual orientation is called “conversion therapy” or “sexual orientation change efforts (SOCE)” , but this practice is widely discredited as unethical, harmful, and ineffective. Gender identity disorder is different from sexual orientation, and psychotherapy is endorsed as the first line treatment by the Dutch Protocol and several progressive European countries, including England’s National Health Service.

States that have raised the age to at least 18 for gender modification interventions, strictly regulate the practice, or define it as child abuse, OR prevent restrictions on psychotherapy for gender identity disorder.

States that have partially restricted gender modification interventions for minors, have pending legislation, or ongoing investigations.

States that act as "sanctuaries", or have pending "sanctuary" laws, for gender modification interventions for minors, OR bans against psychotherapy for gender identity disorder.

No laws, regulations, or active bills restricting or creating "sanctuaries" for gender modification interventions for minors.

Last Updated: July 3rd, 2023

Federal Statutes and Regulations

Section 1557 of the Patient Protection and Affordable Care Act Adds Gender Identity as Protected Category
May 2016

The Affordable Care Act (ACA) passed in 2010. Later, Section 1557 underwent a rulemaking process (with a final rule published in 2016) adding gender identity as a federally mandated protected class, thereby requiring participating entities to provide medical care and insurance coverage. Litigation on this rule has been ongoing.
regulation
Proposed Regulation from the Department of Health and Human Services
August 2022

The Department of Health and Human Services (HHS) issued this proposed rule on Section 1557 of the Affordable Care Act (ACA). This rule reasserts the earlier 2016 effort (which is under litigation), again adding gender identity as a protected category and related medical treatment as covered under federal healthcare programs. Issued on August 4, 2022 in "Final Rule Stage". As of June 9, 2023, rule is not advanced or finalized.
Proposed Rule
FAIR Issues Letter Opposing the Section 1557 Expansion into Gender Identity
September 2022

During the open comment period for the proposed August 2022 regulation, the Foundation Against Intolerance & Racism submitted a letter expressing concern for healthcare providers’ freedoms of religion, conflict of conscience, and professional medical judgment.

FAIR urges the Department to amend the rule, and acknowledge the debate that exists within the medical community.
Letter
FDA Warning for Puberty Blockers in Children
July 2022

The FDA issued a warning about the risk of pseudotumor cerebri, or brain swelling, when certain puberty blockers are used in children. The FDA reports 6 cases, 5 for the use in precocious puberty and one related to transgender care.
FDA Warning
HB 1276 - United States House of Representatives
March 2023

Proposed law to ban gender modification medical services for minors, extends the medical malpractice window to 30 years after age 18.
Bill
S. Bill- United States Senate
March 2023

Proposed law to ban gender modification medical services for minors, extends the medical malpractice window to 30 years after age 18.

Bill
Transgender Bill of Rights
March 2023

A joint resolution in the House of Representatives and Senate to make gender identity a new protected class under Title VII of Civil Rights Act of 1964.

Resolution
HR 3887- Unites States House of Representatives
June 2023

A bill to cut funds to children's hospitals for their medical education programs if they provide gender modification treatments for minors.

Bill

Federal Lawsuits and Decisions

U.S. Court of Appeals 6th Circuit
September 2023

The 6th Circuit Court of Appeals upheld Tennessee (SB 1) and Kentucky (SB150) bans on medical interventions (hormones and surgeries) for gender modifications for minors.

Ruling
Franciscan Alliance Inc. v. Xavier Becerra
August 2022

The 5th Circuit Court of Appeals upheld a permanent injunction prohibiting the Department of Health and Human Services from requiring clinicians to provide services and insurance coverage for gender modification procedures.
Ruling
Eknes-Tucker et al v. Governor of the State of Alabama
August 2023

Case litigating Alabama’s Vulnerable Child Protection and Compassion Act that was partially blocked and appealed to the 11th Circuit Court of Appeals. Oral arguments occurred on November 18, 2022. The final Appeals Court ruling on Aug. 21st, 2023 overturned the lower courts injunction, rejecting the argument that a ban is equivalent to discrimination. Therefore allowing the ban to take effect.
Ruling
The Religious Sisters of Mercy v. Xavier Becerra
December 2022

The 8th Circuit Court of Appeals upheld The Catholic Benefits Association’s right to abstain from providing transgender healthcare services that are in conflict with their religious beliefs.
Ruling
Otto and Hamilton v City of Boca Raton, FL, and County of Palm Beach, FL
November 2020

The 11th Circuit Court of Appeals placed an injunction on an Ordinance based in 2017 by Palm Beach County and the City of Boca Raton law banning psychotherapy for minors with gender identity disorder. The ordinance combined sexual orientation with gender identity disorder. The injunction covers the 11th Circuit states (Alabama, Georgia, and Florida) until the case litigation is complete.

Lawsuit

View Circuit Court map to see which states are affected by Circuit Court cases.

Alabama

Vulnerable Child Compassion and Protection Act
May 2022

The legislature passed this law making it a felony—punishable with up to 10 years in prison or a fine up to $15,000—to provide medical care to minors altering or "affirming" their gender, or for school personnel to hide information from parents.

Lawsuit then filed by the ACLU challenging the law in May 2022.
Law
Eknes-Tucker et al v. Governor of the State of Alabama
May 2022

In this case, a family, backed by the ACLU, sued the State of Alabama in May 2022 in order to challenge the Vulnerable Child Compassion and Protection Act.

The court partially upheld the law, allowing hormones for minors while maintaining the ban on surgery. It also upheld the law’s ban on hiding information from parents.

Appealed in Aug 2022 to the 11th Circuit Court of Appeals.

Appeals Court ruled on Aug. 21, 2023 that the ban may take affect.
Ruling
WPATH order
March 2023

U.S. District Judge ruled in favor of the State that WPATH must provide their internal background data that forms their treatment guidelines for gender dysphoric minors.
Court Order

Alaska

This state has no active bills restricting treatments or creating enhanced protections.

Arizona

Senate Bill 1138
March 2022

Law banning gender reassignment surgery for minors under 18 years old. Law takes effect March 31, 2023.

Signed by Arizona Governor Doug Doucy on March 30, 2022.
Law
Senate Bill 1702
Feb 2023

A bill prohibiting hormone medication for the purposes of gender modification in minors.

Bill

Arkansas

SB 199: Protecting Minors from Medical Malpractice Act 2023
Feb 2023

Law extending malpractice liability for medical professionals engaged in gender change treatments for minors.

The law goes into effect summer 2023.
Law
Save Adolescents From Experimentation Act (SAFE)
Act 626 of 2021 - Law passed prohibiting physicians from providing “gender transition” treatments such as hormones, puberty blockers, and surgeries to minors under 18 years old.

The ACLU challenged this law in 2021. The law is currently blocked from enforcement due to an injunction and ongoing litigation.

On June 20, 2023, the law was ruled unconstitutional.
Law-Overturned
Brandt et al v. Rutledge et al
July 2021

Families backed by the ACLU sued the State of Arkansas in Federal Court in May of 2021 to block the enactment of the SAFE ACT law.

The Federal court granted a preliminary injunction blocking enforcement of the law in July 2021, which was upheld by the 8th Circuit Court of Appeals in August 2022.

A trial on the merits of the law concluded in December 2022 in the US District Court for the Eastern District of Arkansas. https://casetext.com/case/brandt-v-rutledge-3

On June 20, 2023 Judge Moody ruled the SAFE Act unconstitutional, violating the 14th Amendment and causing harm by blocking life saving care.

Lawsuit- Successful

California

SB1172 - Psychotherapy Ban for Transgender Identifying Minors
September 2012

Defines psychotherapy for transgender identifying minors as "conversion therapy" by joining gender identity disorder with sexual orientation as an analogous characteristic. Children starting at age 12 may consent to mental therapy. Licensees are subject to professional discipline.
Law
SB107 - Gender-Change Health Care Law
October 2022

Prohibits health care providers, law enforcement and courts in California from aiding in another state’s investigation related to a minor receiving gender change treatments in California.
Law
AB 957 - An Act to Amend Section 3011 of the Family Code
March 2023

A bill amending the State's Family Law to include positive affirmation of a child's transgender identity as a legal aspect of their health, safety, and welfare, thereby the lack of affirmation could be viewed as child abuse. The bill passed the House, and is advancing in the Senate.

Bill

Colorado

HB19-1129
May 2019

Defines psychotherapy for transgender identifying minors as "conversion therapy" by joining gender identity disorder with sexual orientation as an analogous characteristic. Licensees are subject to professional discipline.

Law
SB23-188
April 2023

Governor Polis signed a bill giving legal protections to clinicians and minors receiving gender change services, including subpoena protection from another state, and prohibiting insurance denials or cancellations. Exemptions for sincerely held religious beliefs.
Law

Connecticut

There are no active bills restricting medical treatments (hormones, surgeries) or creating enhanced protections for medical treatments. However, in 2017, Connecticut passed a law banning psychotherapy for gender identity disorder.

Psychotherapy Ban for Minors with Gender Identity Disorder
May 2017

This law equates gender identity with sexual orientation and states psychotherapy for either entity is defined as "conversion therapy" and is illegal for minors to receive.

Law

Delaware

This state has no active restrictions or protections regarding medical treatments (hormones, surgeries) for minors. However, Delaware, in 2018, passed a law banning exploratory psychotherapy for minors with gender identity disorder.

Psychotherapy Ban for Minors with Gender Identity Disorder
July 2018

This law categorizes gender identity with sexual orientation and states psychotherapy exploring the roots of either entity is defined as "conversion therapy" and is illegal for minors. Mental health professionals are subject to disciplinary action, and they are not allowed to refer minors to another jurisdiction offering psychotherapy for gender identity disorder.

Law

Florida

Medicaid Coverage Determination
June 2022

The Florida Medical Board determined that gender change treatments for minors is experimental, and therefore not eligible for Medicaid coverage.

Several lawsuits have been filed against Florida's Medicaid program.

Some gender medicine clinicians filed a rebuttal to the report.

Regulation
Medical Board Ruling
February 2023

Florida’s Board of Medicine and Osteopathic Board of Medicine finalized a rule in Feb 2023 determining that gender change treatments for minors are illegal for licensed physicians in Florida. Minors being treated with hormones prior to the effective date may continue using the medications. The Medical Board is being sued. The Medical Board is tasked with developing guidelines for minors who will continue to use hormones.

Rule effective March 16 2023.

Regulation
CS/SB254
May 2023

Bill allowing the State to take custody of a minor threatened with or receiving gender modification medications or procedures, prohibiting minors from receiving or using State funds for sex change treatments, clinician licensure loss, and creating civil penalties with a 20 year window. Substituted for companion House bill CS/CS/HB 1421.

Signed into law May 17th, 2023 and immediately in effect.

Lawsuit filed on May 17th asking for an Emergency Order to block the law. On June 6th, a Federal junction granted a Preliminary Injunction allowing the three children (Plaintiffs) to continue receiving hormonal treatments. The law remains in effect for everyone else. Read the decision here.
Law-partial Block
CS/SB 1580: Protections of Medical Conscience
May 2023

Law allowing health care clinicians and insurers to opt out of providing certain treatments based on their conscience based beliefs, such as religious beliefs. Effective date 7/1/23.

Law

Georgia

SB140
March 2023

This law bans the use of hormones and surgery for gender change in minors. Clinicians are subject to Medical Board administrative action for violations. Exemptions include minors who started hormones prior to July 1, 2023 will be allowed to continue use.
Law

Hawaii

HB891
April 2023

A bill prohibiting gender change surgery for minors and establishing the procedure as a Class A felony.
Bill

Idaho

House Bill 71
April 2023

A law that makes it illegal for clinicians to use hormone medications and surgeries for gender change treatments of minors.

An Idaho Judge placed an emergency injunction on 12/28/23 preventing the law from taking affect on January 1st, 2024 while the ACLU lawsuit is decided.

https://www.acluidaho.org/en/press-releases/families-block-idaho-law-banning-health-care-transgender-youth

Law

Illinois

HB4664 - Reproductive and Gender Affirming Health Care Bill
Jan. 2023

Law shielding gender change patients and treatment providers from legal action initiated outside of Illinois, as well as action that includes parties both within and outside of Illinois, and requiring gender-change health care medications to be covered by insurers at no cost to the consumer.

Gov. Pritzker's press release.

Law

Indiana

SB 480
April 2023

Prohibits hormone medications and surgical services for gender modification of minors, including aiding or abetting such services. The malpractice window extends until the patient is age 28. Hormone prescriptions will be discontinued on January 1, 2024.

On June 16th, 2023, a Federal judge placed a preliminary injunction blocking enforcement of the hormone ban and sanctions for referrals, but kept the surgery ban in place.

Read more here.
Law-Partial Block
HB 1118
Prohibits medical and mental health clinicians in healthcare facilities or schools from engaging in interventions to alter a minor’s biological sex. Knowledge of such activities requires mandatory reporting to child services or police with provision for immunity. Clinicians may face misdemeanor and felony charges as well as potential disciplinary action against their license.
Bill

Iowa

SF 538
March 2023

Bans the use of medications and procedures for gender modification treatments of minors.
Law

Kansas

SB 12
January 2023

A bill to criminalize gender modification treatments for minors, including hormones and surgeries, and providing grounds to classify such interventions as unprofessional for medical licensees.
Bill
SB 233
April 2023

Bill passed creating civil penalties and license removal for a physician who performs gender modification treatments and services for minors.Vetoed by governor.

Bill (Vetoed)

Kentucky

Senate Bill 150
March 2023

A law making gender modification medications and procedures illegal for minors. If a clinician violates the law, they are subject to potential loss of medical license, with a malpractice window going up to a patient age of 30 years old. The law takes effect July 1, 2023.

On June 28, 2023, a federal judge granted a preliminary injunction blocking the hormonal intervention ban while the surgical ban remains in place during the ACLU adjudication. In September 2023, the 6th Circuit Court of Appeals ruled that SB150 and TN SB 1 are constitutional and may take effect. Read the 6th Circuit Opinion here.


Law
ACLU Lawsuit
May 2023

An ACLU backed lawsuit asking for a preliminary injunction to block the SB 150's implementation on July 1st, 2023, while suing the State to overturn the law on the claim it is unconstitutional. A preliminary injunction was granted on June 28th, 2023 blocking the ban on hormone interventions while retaining the ban on surgical procedures.

In September 2023, the 6th Circuit Court of Appeals ruled that SB150 and TN SB 1 are constitutional and may take effect. Read the 6th Circuit Opinion here.


Lawsuit-defeated

Louisiana

HB 648 (Stop Harming Our Kids Act)
July 2023

A law making gender modification medications and procedures for minors illegal. Includes malpractice window up to age 40, and sunset for hormonal prescriptions until Dec. 31, 2023. Clinician licenses may be revoked for 2 years. Vetoed by the Governor. Overridden by the Senate. Takes effect 1/1/2024.

Law

Maine

LD 1735
April 2023

A bill advancing to prevent legal action from an outside state to be enforced in Maine related to gender modification treatments for minors. Tabled 5/17/23.

Bill

Maryland

SB 460 (Trans Health Equality Act)
May 2023

A law requiring Maryland Medicaid to cover gender modification treatments.

Law

Massachusetts

Chapter 127
July 2022

Emergency law passed making gender modification treatments at any age a “legally-protected health care activity” and blocks actions from other states’ laws in this area.
law

Michigan

SB 4
March 2023

Law passed adding gender identity and expression as protected classes under Michigan’s state level civil rights law.

Law

Minnesota

Executive Order
23-03
March 2023

Reinforces gender modification treatments as “medically necessary” and covered by insurance, empowers agencies to investigate “unfair” practices, requires no assistance from state agencies for outside state actions, protects against extradition, and the Department of Health must submit a comprehensive report by Dec. 31, 2023 about the safety and efficacy of these treatments.
Executive Order
HF 146
April 2023

A “sanctuary bill” for transgender minors and clinicians involved in gender modification treatments by protecting them from legal charges in another state related to prohibitions.

Signed into law April 24th, 2023.
Law

Mississippi

HB 1125 Regulate Experimental Adolescent Procedures (REAP) Act
February 2023

Prohibits gender modification medications and procedures for minors, including insurance coverage to pay for such services. Health care professionals are subject to licensure removal if they break the law.
Law

Missouri

 There are no  regulations restricting psychotherapy for gender distress.

Attorney General Investigation
February 2023

Missouri Attorney General Andrew Bailey launched a multiagency investigation into the Pediatric Transgender Center at St. Louis Children’s Hospital to evaluate alleged patient harm, violations of professional conduct by licensed practitioners, and billing fraud. The investigation was triggered by a whistleblower at the Center. The whistleblower's affidavit is linked below. The hospital's investigation report is here.
Investigation
Attorney General Regulation
April 2023

Attorney General Andrew Bailey creates specific regulations outlining practice safeguards for gender dysphoric minors, including specific informed consent documenting experimental nature of the treatments, and requiring mandatory therapy for 18 months prior to starting medications or receiving surgery. Rule effective April 27, 2023 to Feb 6, 2024. The ACLU won a temporary restraining order granted through May 15th, 2023.

An injunction was filed in State Circuit Court by the ACLU and others to block the regulation. Hearing set for May 11th, 2023.

On May 16th, AG Bailey withdrew this Regulation.
Regulation
SB 49
April 2023

A bill banning gender modification medications and procedures for minors. Prescriptions written prior to Aug 28, 2023 may be refilled through Aug. 28, 2027. Prohibits Medicaid funds for gender modification, and bans related surgeries for inmates. Signed into law June 7th, 2023.

Law
Emergency Resolution No. 230385
May 2023

The City Council of Kansas City passed an Emergency Resolution to designate the city as a sanctuary for patients seeking or receiving gender modification treatments, and the clinicians providing such treatments.

Resolution

Montana

Senate Bill 99
April 2023

A law making it illegal to prescribe medication or perform gender modification surgery for minors.
LAW

Nebraska

LB 574 - Let Them Grow Act
January 2023

A bill passed to prohibit gender modification treatments for minors under age 19 and allow damages up to 2 years. Signed by Governor May 22, 2023.

Law

Nevada

SB302
April 2023

Bill passed the Nevada Senate creating certain protections for clinicians’ licenses against sanction, and subpoena protections from other states' legal actions for patients and clinicians involved in gender modification treatments for minors. No further actions taken.

Bill

New Hampshire

HB 417
March 2023

A bill advancing to categorize gender modification treatments for minors as child abuse under The Child Protection Act, and therefore subject to mandatory reporting and investigation. The bill did not pass this legislative session.

Bill

New Jersey

Psychotherapy Ban
August 2013

A law categorizing gender identity as the same as sexual orientation, and stating that psychotherapy exploring the roots of gender identity distress is unlawful because it is equivalent to the discredited therapy practice to change a person's sexual orientation. Signed by Governor Chris Christie.

Law
Executive Order No. 326
April 2023

"Governor Phil Murphy signed an Executive Order establishing New Jersey as a safe haven for gender-affirming health care by directing all state departments and agencies to protect all persons, including health care professionals and patients, against potential repercussions resulting from providing, receiving, assisting in providing or receiving, seeking, or traveling to New Jersey to obtain gender-affirming health care services."

Executive Order

New Mexico

HB 7
March 2023

Law passed designating medical treatments for gender modification interventions as a civil right protected against discrimination. Each violation of discriminatory action is a $5,000 fine.
Law

New York

Division of Human Rights
January 29th, 2020

New York's Division of Human Rights has published a document called "Guidance on Protections from Gender Identity Discrimination" under New York State's "Gender Expression Non-Discrimination Act" (GENDA) law. Issued on January 29, 2020.

Legal Enforcement Guidance.

Guidance
NYC Executive Order No. 32

June 12, 2023

Mayor Eric Adams signs an Executive Order for City workers, resources, and facilities: 1) Various protections for those providing gender modification treatments and patients receiving such treatments such as requiring patient consent and agency legal review before complying with outside court orders 2) Restates psychotherapy ban for gender identity disorder 3) Protects telehealth care.


Resolution

North Carolina

HB 43
February 2023

A bill advancing in the House to prohibit hormones and surgeries for gender modification for minors. Provisions to revoke a physician's license and charge civil penalties for violations.

Bill
SB 560
April 2023

A bill advancing in the Senate to outline criteria for the legal practice of gender dysphoria treatment and gender modification therapies, including psychological treatments, medications, and surgeries.

Provisions include: no aspect of care may be completed over telehealth platforms, a prewritten consent form outlining specific risks must be signed, two physicians from different institutions must complete an evaluation, and clinicians are subject to civil penalties 15 years after treatments.
Bill
HB 808 (S639)
April 2023

A bill passed to raise the age of gender modification medications and surgery to 18 years of age and older. Exceptions for those who started treatment before Aug.1st, 2023, physician deems medically necessary, and have an updated parental consent. Sent to the Governor on June 30, 2023 who vetoed it. The legislature overrode the veto in Aug 2023.

Law

North Dakota

HB1254
April 2023

A law prohibiting gender modification medications and surgical procedures for minors. Surgeries are classified as a felony, and prescribing hormones are classified as a misdemeanor. Grandfather clause for minors receiving hormone s prior to law taking effect. Signed by the Governor on April 19th, 2023.

In Nov 2023, a judge blocked a restraining order on the law requested by plaintiffs suing the state. https://www.foxnews.com/us/judge-rejects-initial-attempt-temporarily-block-north-dakota-ban-gender-transition-treatment-minors

Law

Ohio

Save Adolescents from Experimentation Act (SAFE)- HB 68
January 2024

A bill prohibiting medical and surgical interventions for gender modification of minors. Grandfather clause for those on hormones. Passed the House in June 2023 and Senate in December 2023. Governor DeWine vetoed the bill, but hie veto was overridden by the House and Senate, becoming law in January 2024.

Law

Oklahoma

Senate Bill 3XX
October 3, 2022

Governor Kevin Stitt signed SB 3XX which blocks funding to prevent gender modification interventions for minors at Oklahoma Children’s Hospital at OU Health.
Law
Senate Bill 613
A law prohibiting gender modification medications and procedures for minors. Licensed healthcare practitioners will be subject to Medical Board investigation, civil and criminal penalties. In May, the State agreed to hold enforcement of the law pending the litigation process for ACLU lawsuits.
Law-blocked

Oregon

Senate Joint Resolution 33
April 2023

Resolution to create a ballot initiative for the November 2024 election to add gender identity to Oregon’s State’s Constitution as a protected class against discrimination.
Resolution
HB 2002
May 2023

Currently in Oregon, anyone age 15 and older can seek gender modification interventions without parental consent or notification. An amendment removed a provision that required State health insurance to cover some services for detransitioners, and "all medically necessary gender-related services that are prescribed in alignment with accepted standards of care."
Bill

Pennsylvania

HB138
March 2023

A bill advancing to extend the malpractice window for 30 years from age 18 yo to bring lawsuits against clinicians involved in a minor’s gender modification interventions.
Bill

Rhode Island

SB 958
May 2023

A bill advancing to prohibit gender modification interventions for minors, discipline for health care clinicians involved in such interventions, a thirty (30) year statute of limitation, right to a civil action for damages.

Bill
Rafferty Lawsuit in RI
Oct 2023

A lawsuit filed by a plaintiff with a history of multiple mental health diagnoses against Dr. Jason Rafferty, author of the American Academy of Pediatrics Guidelines on Gender Care, alleging medical malpractice, lack of informed consent, and irreversible damage.

Lawsuit

South Carolina

S. 627
March 2023

A bill prohibiting gender modification medication and procedures for minors or public financing for such medical interventions.
Bill

South Dakota

House Bill 1080
February 2023

Bans hormones and medical procedures to modify the gender of a minor. Medical professionals are subject to having their license revoked.

Law

Tennessee

SB 1
March 2023

Law prohibiting gender modification medications or procedures for minors. The law takes affect July 1, 2023. Patients undergoing treatments before the law takes effect will have their care end by March 31, 2024. The Justice Department and ACLU filed a lawsuit and an injunction to block the implementation while their lawsuit advances in the courts.

A preliminary injunction was granted on June 20, 2023, partially blocking the law from taking effect on July 1, 2023. The ban on surgical interventions for minors took effect but hormone treatments were allowed while the ACLU case was litigated at the 6th Circuit Court. On September 28th, 2023, the 6th Circuit Court of Appeals upheld SB1 and Kentucky SB150, allowing hormonal bans to take effect. Read the 6th Circuit Opinion here.
Law
Justice Department and ACLU Lawsuit
April 2023

A Federal lawsuit claiming SB1 is discriminatory and violates the plaintiffs' 14th Amendment rights, denying them medically necessary care. Included a request for a temporary injunction to block the law from taking effect on July 1, 2023, which was granted in part on June 20, 2023 by allowing the ban on surgery to take effect while blocking the ban on hormone medications. In September 2023, the 6th Circuit Court of Appeals ruled against the ACLU, allowing TN SB1 and Kentucky SB150 to take effect. 6th Circuit Ruling .

Lawsuit-defeated
State AG Investigating Potential VUMC Billing Fraud
June 2023

The TN AG is investigating potential billing fraud at the Vanderbilt University Medical Center's transgender clinic.

AG Investigation

Texas

Attorney General Opinion
February 2022

Opinion No. KP-040 - Attorney General Ken Paxton's advisory opinion in Feb 2022 to Texas legislature to include gender modification interventions under the legal definition of child abuse in Texas.

AG Opinion
Letter from Governor Abbott
February 2022

Gov. Greg Abbott sent a Letter to the Department of Family and Protective Services (DFPS) informing them that child gender modification activities fall under rules of mandatory reporting for child abuse to the State.

Letter
Doe vs. Abbott
March 2022

Doe family sued Gov. Abbott, DFPS Commissioner, and DFPS over the rule to categorize medical treatments for youth gender dysphoria as child abuse and to investigate families.In March 2022, the 3rd Circut Court in Texas blocked the order, and in May 2022, the Texas Supreme Court upheld the lower court’s ruling to block the State from investigating families.
Lawsuit
Pflag vs. Abbott
April 2022

Pflag and several families sued Gov. Abbott, DFPS Commissioner, and DFPS over the rule to categorize medical treatments for youth gender dysphoria as child abuse and to investigate families. The case is currently on appeal in the Third Circuit Court of Texas.
Lawsuit
HB 3502
April 2023

A bill advancing in the House to require insurance companies to pay for medical services related to complications and adverse effects from medical gender modification or detransition, including for minors. Placed on General State Calendar on 5/10/23.

Bill
Inves­ti­ga­tion into Dell Children’s Med­ical Cen­ter
May 2023

Attorney General Paxton announced an investigation into the Dell Children’s Medical Center to uncover whether gender modification procedures were unlawfully performed on minor children.
Investigation
SB 1029
May 2023

A bill prohibiting government funds for gender modification treatments, requiring insurance companies to pay for all costs for care, medications, follow-ups, complications, and reversals for life, and clinicians involved to be liable for the life of the patient. Stalled in State Affairs Committee 5/6/2023.
Bill
SB 14
May 2023

Bill raising the age of gender modification treatments to 18 years of age, provision to revoke medical licenses, and ban state Medicaid money to be used for such treatments. Signed by the Governor June 2nd, 2023. Effective September 1st, 2023..

Law
SB 21
June 2023

A Bill introduced that creates a private right of action to sue clinicians for civil damages relate to the adverse effects of medical treatments for.gender dysphoria, including hormones and surgeries. Exposure window is up to 20 years post medical treatment.

Bill

Utah

S.B. 16 Transgender Medical Treatments and Procedures Amendments
January 2023

Bans medical service to modify the gender of a minor with gender dysphoria.

Law

Vermont

H. 89
May 2023

A law defining gender modification interventions for minors as a legally protected medical service, and prohibits legal action from another state against persons involved in such interventions.

Law
S. 37
May 2023

A law prohibiting licensing board disciplinary action for clinicians involved in gender modification interventions, requiring Vermont’s public institutions of higher education to adopt gender modification interventions, prohibits a medical malpractice insurer from adjusting a health care clinician’s risk classification or premium charges, and requires a health insurance plan covers gender modification services.
Law

Virginia

Three healthcare related bills restricting gender modification interventions for minors were defeated during the 2022-2023 session: SB 791SB 960, and SB 1203. There are no “sanctuary” bills pending.

Washington

Senate Bill 5599
May 2023

A law passed to allow licensed shelters to contact the Department of Children, Youth and Families (DCYF), rather than parents or legal guardians, when a minor presents to a shelter and is seeking gender modification interventions. Effective July 23, 2023.

Law

West Virginia

HB 2007
March 2023

A law prohibiting gender modification medications or surgical procedures for minors. Effective January 1st, 2024.

Law

Wisconsin

This state has no active bills restricting treatments or creating enhanced protections.

Wyoming

Two healthcare related bills restricting gender modification interventions for minors were defeated: SF 144 and SF 111. No “sanctuary” bills introduced.

International Reference

Given the number of countries that have some policy or practice about youth gender transition care, this table is incomplete. We have emphasized larger developed countries where current practice is well-defined. For comparison we show recommendations of the latest version of ‘Standards of Care’ from WPATH, the World Professional Association for Transgender Health. Readers with more up-to-date information are encouraged to help us update the table.

 

Finland

Sweden

Norway

United Kingdom

Year & Authority

 

July 2020 Council for Choices in Health Care

December 2022 National Board of Health and Welfare 

March 2023 Norwegian Healthcare Investigative Board

Judicial review in 2020

NICE reviews of cross-sex hormones and puberty blockers, March 2021

Cass Interim Report Feb. 2022

NHS Update May 2023

NHS Update Implementing Advice from Cass Review June 9, 2023 

General Guideline 

First line treatment should be psychosocial support, gender-explorative therapy, treatment of comorbid conditions.

Report

 

Summary of National Guidelines for Children and Adolescence with Gender Dysphoria: Link

 

Systematic review of puberty blockers and hormones

Norwegian Healthcare Investigation Board (Ukom) Report 

NHS Update May 2023 and NHS Update June 2023

* Establishes regional hubs affiliated with children’s hospitals

*Research oversight Board

*Determining standards for data collection and  longitudinal tracking

*Psychotherapy first

*Puberty blockers only within research settings

Social Transition

 Not specified

 Not specified

 Not specified

“Not a neutral act”

Puberty blockers

 Not recommended

Risks outweigh benefits. Use only in research setting

“Experimental”

Only in clinical trial research settings if <18 yo

Cross-Sex hormones

Only if early childhood onset and no mental health issues which could interfere with the gender dysphoria diagnosis

Risks outweigh benefits. Use only in research setting

“Experimental”

16+

Mastectomy

18+

18+

“Experimental”

 Not specified

Genital surgery

18+

 18+

“Experimental”

 Not specified

Notes

Blockers and hormone allowed in rare circumstances but “no decisions should be made that can permanently alter a minor’s mental and physical development.”

The NBHW states “Risks outweigh benefits at a group level”.

Non-binding report. Finland officially follows WPATH SOC 8.

Closed Tavistock late 2022, “not a safe place for children”

 

 

 

Netherlands

Spain

Australia

WPATH 8.0

Year & Authority

 

Original home of the ‘Dutch protocol,’ but clinics are loosening eligibility criteria

Feb 2023 passed national Trans Law

2020. Royal Children’s Hospital, Melbourne, Standards of Care, v 1.3 Endorsed by AusPATH

2022. Standards of Care 8.0

General Guideline 

No official guideline. Original protocol evolving: rising case load, switch to predominance of natal girls, later referrals, less extensive psychological support

Bill broadly addresses societal aspects of LGBTQ integration, and deals with youth gender care only in a limited way

Children can change legal sex from age 12 w/o medical attestation

Largely followed WPATH 7.0

Compared to version 7, removed minimum ages for blockers, hormones, and surgery

Social Transition

Part of protocol

Supported at any age

Endorsed at any age

No minimum age

Puberty blockers

Part of protocol

Not specified

“reversible” No minimum age; begun at Tanner Stage 2 

No minimum age

Cross-Sex hormones

Part of protocol

Not specified

No minimum age

No minimum age

Mastectomy

Part of protocol

Not specified

Probably ok at 16

No minimum age

Genital surgery

Part of protocol

12+

Best deferred to adulthood

No minimum age

Notes

 ——–

Bans counseling which tries to halt or reverse transition process, even at request of patient

Australia’s most populous state, NSW, is funding expansion of medical transition services

 ———-

 

 

Canada’s policies are generally supportive of the Dutch Protocol, but each province has its own health authority and delivery system. For instance, the British Columbia Provincial Health Services Authority follows WPATH standards closely, and facilitates transition for people of all ages through “Trans Care BC.” 

France does not have an official national policy. However in February 2022 the French National Academy of Medicine released an opinion noting an ‘epidemic-like phenomenon’ across the developed world,’ opining that “a great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population and the many undesirable effects, and even serious complications, that some of the available therapies can cause.” 

 New Zealand shares many medical guidelines and specialty societies with Australia, including the Royal Australian and New Zealand College of Psychiatrists, which has tried to take a mediating position, and in 2021 affirmed (against the ‘informed-consent’ model) the need for careful psychiatric evaluation and support of gender-conflicted youth. In September 2022, the New Zealand Ministry of Health, recognizing trends in Europe, removed its support of puberty blockers as “a safe and fully reversible medicine” and simply described blockers as “a medicine that can be used to halt the progress of potentially unwanted puberty-related physical changes.” 

For more detailed information on several countries, see this summary maintained by French autism advocate Magali Pignard.